The effect of repetitive transcranial magnetic stimulation on food choice‐related self‐control in patients with severe, enduring anorexia nervosa

Abstract

ObjectiveIndividuals with anorexia nervosa (AN) pursue low‐fat, low‐calorie diets even when in a state of emaciation. These maladaptive food choices may involve fronto‐limbic circuitry associated with cognitive control, habit, and reward. We assessed whether high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) influenced food‐related choice behavior in patients with severe, enduring (SE)‐AN.MethodThirty‐four females with SE‐AN completed a Food Choice Task before and after 20 sessions of real or sham rTMS treatment and at a 4‐month follow‐up. During the task, participants rated high‐ and low‐fat food items for healthiness and tastiness and then made a series of choices between a neutral‐rated food and high‐ and low‐fat foods. Outcomes included the proportion of high‐fat and self‐controlled choices made. A comparison group of 30 healthy women completed the task at baseline only.ResultsBaseline data were consistent with previous findings: relative to healthy controls, SE‐AN participants showed a preference for low‐fat foods and exercised self‐control on a greater proportion of trials. There was no significant effect of rTMS treatment nor time on food choices related to fat content. However, among SE‐AN participants who received real rTMS, there was a decrease in self‐controlled food choices at post‐treatment, relative to baseline. Specifically, there was an increase in the selection of tasty‐unhealthy foods.DiscussionIn SE‐AN, rTMS may promote more flexibility in relation to food choice. This may result from neuroplastic changes in the DLPFC and/or in associated brain areas.

A comparison of food‐based decision‐making between restricting and binge‐eating/purging subtypes of anorexia nervosa

“…Examination of actual food choices, and the influence of individualized food valuation ratings on food choice, may help clarify similarities and differences in components of decision‐making between the subtypes of AN. In the present study, we used a Food Choice Task previously shown to capture restrictive food choice in individuals with AN (Dalton et al, 2020; Foerde, Steinglass, Shohamy, & Walsh, 2015; Steinglass, Foerde, Kostro, Shohamy, & Walsh, 2015) and relate to actual food intake the following day to examine whether food‐based decision‐making differs between AN subtypes.…”

Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives

“…Several studies suggest that a higher number of rTMS sessions give better clinical results [26,27]. An ancillary analysis of the sample of a randomized controlled feasibility trial on rTMS [26], using a food choice task, found a decrease in self-controlled food choices, suggesting than rTMS may promote more flexibility in relation to food choices [28]. Finally, the feasibility and safety of rTMS of DLPFC in patients with AN have been confirmed by these randomized controlled trials [25][26][27].…”

“…Stimulation of deeper areas using an H coil might be more effective, leading to enduring benefits. With the exception of Dalton et al [28,44], the randomized controlled studies only proposed a limited number of pulses and 1 to 10 sessions (i.e., about 10,000 pulses maximum). It is likely that more sessions are needed to modify neural programs and their associated behaviors.…”

Food Folio by Columbia Center for Eating Disorders: A Freely Available Food Image Database

“…Analyses were rerun with the (76-item) subset of foods that has been used as part of the Food Choice Task in multiple existing studies with eating disorder populations (e.g., Foerde et al, 2015;Dalton et al, 2020). Differences between low-fat and high-fat foods were more pronounced in analyses with the 76-item subset; however, outcomes did not qualitatively differ from those of the primary analysis, and are presented in the Supplementary Information (Part 2) and Supplementary Tables (File 2).…”

“…The consistency of items across stimulus set and laboratory meal better enables assessment of whether tasks involving the image set predict actual eating behavior (e.g., Foerde et al, 2015Foerde et al, , 2020. The food images have been used in tasks designed to capture the persistent selection of low-fat food items across eating disorders in the United States (e.g., Foerde et al, 2015Foerde et al, , 2020Gianini et al, 2019) and United Kingdom (e.g., Steinglass et al, 2015;Dalton et al, 2020). The same images have been used to study cognitive mechanisms involved in food-choice decision-making that may differentiate individuals with anorexia nervosa from healthy individuals (Bakkour et al, 2018).…”